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Prospective Evaluation of Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Approach: Minimum 5 Year Follow Up

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Written by Y.J. Kim, M.D., Lawrence G. Lenke, MD and Keith Bridwell, MD

Abstract from the SRS 2002 Annual Meeting

Purpose: To evaluate pulmonary function changes 5 years or more prospectively after surgery in patients with AIS relative to the type of surgical approach used for the spinal arthrodesis.

Methods: 109 patients with AIS undergoing surgical treatment were prospectively evaluated with pulmonary function tests (PFTs) , forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) preoperative, 3 months, 1 year, 2 years, and a minimum 5 years postop (5-14 years). All patients were divided into four groups. Group 1 (n=43) posterior spinal fusion with iliac crest bone graft (PSF-IC); Group 2 (n=39) PSF with thoracoplasty (PSF-TP); Group 3 (n=15) anterior spinal fusion (ASF) with a rib resection thoracotomy (ASF-TC); and Group 4 (n=12) combined ASF and PSF with autogenous rib and iliac crest graft (ASF/PSF).

Results: Irrespective of the surgical approach used for the spinal arthrodesis, postop PFTs (absolue values) improved continuously until 2 years after surgery, then did not change between 2 and 5 years follow up, except group 1(PSF-IC) that continue to improve up to 5 years postop. Five years following surgery, Group 1 had statistically increased PFTs both in absolute value and percent predicted, while patients in Groups 2, 3 and 4 had unchanged (Groups 2,4) or significantly decreased (Group 3) pulmonary function values (p <0 .05).

	PRE FVC/FEV-1	3M PO	1Y PO	2Y PO	5Y PO
G 1 PSF-IC (N=43)	2.80/2.39	2.86/2.43	2.94/2.46	3.13/2.70	3.26/2.76
G 2 PSF-TP (N=39)	2.92/2.39	2.47/2.10	2.74/2.30	3.04/2.56	3.04/2.52
G 3 ASF-TC (N=15)	3.09/2.69	2.44/2.39	2.71/2.47	2.96/2.56	2.83†/2.42†
G 4 ASF/PSF (N=12)	2.38/2.00	2.11/1.65	2.33/1.96	2.44/2.09	2.54/2.15
G 2+3+4 (N=66)	2.85/2.41	2.39/2.10	2.64/2.27	2.91/2.47	2.91/2.43

* = improved vs. preop (p <.05) † = decreased vs preop (p < .05)

Conclusions: Irrespective of the surgical approach used, postoperative pulmonary function tests (absolute values) increase until 5 years after surgery. Patients who had no chest cage disruption (Group 1) had a significantly greater improvement in their pulmonary function values at 5 years after surgery than patients with chest cage disruption (Group2,3,4).

Updated on: 12/10/09